CLAY, Circuit Judge.
Plaintiffs, the Estate of Frieda M. Wilmes through its appointed fiduciary, Claudette Schenck, Robert K. Espel, and James C. Matacia (collectively "Plaintiffs"), on behalf of themselves and all other similarly-situated employees and retirees, appeal the district court's order granting summary judgment to Defendants Anthem, Inc., Anthem Insurance Companies, Inc., Community Insurance Company, and the City of Cincinnati (collectively "Defendants") pursuant to Fed.R.Civ.P. 56. Plaintiffs seek to recover funds they alleged were owed to them when Anthem Insurance Companies, Inc. demutualized in 2001 and issued 870,021 shares of stock to the City of Cincinnati, Plaintiffs' employer, instead of to Plaintiffs.
For the reasons set forth below, we
On October 15, 2008, Plaintiffs filed a complaint to recover on behalf of themselves and all other similarly-situated employees and retirees of the City of Cincinnati, Ohio (the "City") the current value of the 870,021 shares of Anthem common stock that the City received from the demutualization of Anthem Insurance.
On September 1, 2009, Plaintiffs filed a motion for class certification. The district court granted Plaintiffs' motion and certified the proposed class. The class consists of 2,536 employees and retirees of the City who were named as insured persons, or former members of a group of insured persons, covered under a health care group policy from June 18, 2001 through November 2, 2001. The class includes two subsets: "Class A" members were defined as individuals who had an insurance policy with Anthem prior to the merger between Community Mutual Insurance Company ("CMIC") and Anthem in 1995; and "Class B" members were defined as individuals who received a health insurance group policy after the 1995 merger. The district court designated Schenck, Espel, and Matacia to serve as the class representatives of both classes.
The parties proceeded to discovery, after which they filed cross motions for summary judgment. On March 3, 2010, the district court denied Plaintiffs' motion for summary judgment; granted Anthem's cross-motion for summary judgment; granted in part the City's cross-motion for summary judgment; and dismissed the case. Plaintiffs timely appealed.
We have jurisdiction pursuant to the Class Action Fairness Act of 2005, which extends the diversity jurisdiction of the federal courts to certain class actions.
In 1986, the City of Cincinnati entered into a Master Group Contract for various
(R.32-2: Ex. B. CMIC Bylaws § 1.01.) Schell stated that the City's group contract was "renewed each year between 1986 and 1999."
Anthem Insurance's predecessor was Associated Insurance Companies, Inc. ("Associated"), an Indiana mutual insurance company. In the early 1990s, Associated began acquiring BC/BS licenses in Kentucky (1993) and Ohio (1995). The Ohio BC/BS licensee that was acquired on October 1, 1995 was CMIC. At the time of the 1995 merger between CMIC and Associated, CMIC members received the following:
(R.31-23: PTX-20, Page ID # 1560.)
CMIC and Associated jointly petitioned the Ohio Department of Insurance ("Ohio DOI") for approval of the merger. Both
(R.31-16: PTX-12, Page ID # 1497) (emphasis added).
According to the terms of the merger agreement, the City received a Group Guaranty Policy, which confirmed that it was a member of Associated, and the policy also indicated that City employees who obtained coverage as enrollees in the City's group policy were not members of nor had equity rights in Associated. The Ohio DOI approved the merger and the agreement became effective on October 1, 1995. After the merger, Associated changed its name to Anthem Insurance Companies, Inc.
In 2001, Anthem developed a Plan of Conversion to convert Anthem Insurance from an Indiana mutual insurance company to an Indiana stock insurance company in accordance with Indiana demutualization law under Indiana Code § 27-15-1-1, et seq. Anthem decided to demutualize in order to increase the company's financial flexibility through improved access to capital. Under the Indiana Demutualization Law, Anthem was required to provide consideration, either in the form of cash or stock, to its eligible statutory members in exchange for their membership interests. During this process, Anthem retained both financial and legal advisors as well as other experts to provide assistance in executing the conversion plan.
On May 18, 2001, Anthem notified the Ohio DOI, as required under Ohio Rev. Code § 3941.38, of its plan to convert to an Indiana stock insurance company. Anthem also submitted a Form D Filing to the Ohio DOI, which notified the Ohio DOI of its intent to (1) "discontinue the issuance of any new Guaranty Policies after the effective date of Conversion;" and (2) "cause all issued Guaranty Policies to expire at their anniversary next following the effective date of the Conversion," which would extinguish all membership interests. (R.32-18: Ex. A. Dec. of Marjorie Maginn.) On September 14, 2001, the Ohio DOI approved Anthem's demutualization request.
(R.32-11: Plan of Conversion, Page ID# 2676-77.) No objections to Anthem's position were raised at the public hearing.
On October 25, 2001, the Indiana DOI published its Findings of Fact, Conclusions of Law, and Order, which found that Anthem complied with the requirements set forth under the Indiana demutualization law. The Indiana DOI approved Anthem's Plan of Conversion on October 29, 2001. That same day a majority of Anthem's Statutory Members also voted to approve and adopt the conversion plan. Anthem's demutualization became effective on November 2, 2001, and on that day, Anthem issued 870,021 shares of its common stock to the City. Upon receipt of the shares of the stock from the demutualization, the City disposed of its shares on the public market and received $55 million. The City used the proceeds to fund a variety of city projects.
On October 15, 2008, Plaintiffs filed this action claiming that the City was not entitled to the $55 million demutualization proceeds and are now seeking to recover that amount.
We review a district court's grant of summary judgment de novo. White v. Baxter Healthcare Corp., 533 F.3d 381, 389 (6th Cir.2008). Summary judgment is appropriate "if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(a). "[T]he evidence and all reasonable inferences drawn therefrom are viewed in the light most favorable to the nonmoving party." Rodgers v. Monumental Life Ins. Co., 289 F.3d 442, 448 (6th Cir.2002) (citing
Plaintiffs argue that the district court erred in concluding that the City obtained rights and interests of the health insurance group policy ("Group Policy") through a "grandfather" clause placed in the pre-merger agreement between CMIC and Associated. Plaintiffs contend that the City was therefore not entitled to receive any proceeds or compensation from the 2001 demutualization of Anthem. Plaintiffs argue that under Ohio insurance law, Ohio Revised Code §§ 3913.22(A) and 3913.20(B), the City was not "named as the insured" or the "policyholder" of the Group Policy because, according to Plaintiffs, "[a] municipality has no health of its own to insure." Plaintiffs assert that only active and retired employees and their dependents may serve as the "named insureds" or "insureds" or policyholder under the Group Policy. We first address the issue of whether the City was the policyholder of CMIC for purposes of obtaining membership rights under the Group Policy.
The district court correctly held that the statutory definition prohibits Plaintiffs from being classified as an owner of the Group Policy. Under Ohio insurance law § 3913.20(B), a policyholder is defined as the "person, group of persons, association, corporation, partnership, or other entity named as the insured under a mutual policy of insurance other than life...." The district court interpreted the statute to mean that policyholders are typically "owners" of the group policy. The district court therefore found that Plaintiffs cannot be the owners of the group policy because as employees and retirees Plaintiffs "had nothing to do with the choice of insurance carrier, nor with its governance, and they received what they bargained with the City to get: insurance coverage." Mell v. Anthem, Inc., No. 1:08-cv-00715, 2010 WL 796751, at *10 (S.D.Ohio Mar. 3, 2010). Moreover, the district court noted that the record provides no evidence that the Group Policy named Plaintiffs as the policyholders of the Group Policy.
Plaintiffs' argument is also incompatible with CMIC's bylaws, which adopted the policyholder definition found under Ohio insurance law. According to CMIC's bylaws, a member was defined as "[e]very policyholder of the corporation" and the "[p]olicyholder means the person or group of persons identified as the named insured in the declarations page of a policy of insurance of the corporation." In the case of the Master Group Contract, the City as the member "shall be the holder of the master policy." CMIC's By-Laws, art I. § 101. The plain language of the bylaws therefore supports the conclusion that even prior to the 1995 merger between CMIC and Associated, the City became a policyholder of the Group Policy by virtue of its contract with CMIC. Under Ohio law, "[t]he words in a policy must be given their plain and ordinary meanings, and only where a contract of insurance is ambiguous and therefore susceptible to more than one meaning must the policy language be liberally construed in favor of the claimant who seeks coverage." Burris v. Grange Mut. Cos., 46 Ohio St.3d 84, 545 N.E.2d 83, 88 (1989), overruled on other grounds by Savoie v. Grange Mut. Ins. Co., 67 Ohio St.3d 500, 620 N.E.2d 809 (1993). No ambiguity exists in the instant case. Based on a straightforward reading
Plaintiffs attempt to insert themselves into the contract by arguing that as "named insureds" or "insureds" they became the "policyholders." However, the Master Group Contract in effect established a contractual agreement between the City and CMIC, with Plaintiffs as mere beneficiaries. As beneficiaries, Plaintiffs enjoyed the right to participate in the insurance provided, under the terms and conditions imposed by the Group Policy. Thus, any references to the "named insured" or "insured" simply meant a person covered under a group policy who is entitled to insurance as a benefit of his/her employment. It does not signify the position of policyholder.
To the extent that Plaintiffs argue that an agency relationship exists between CMIC and the employees and retirees, Plaintiffs' argument misconstrues the Ohio statutory language and CMIC's bylaws. Under Ohio law, "[a]n employer's administration of a group insurance plan does not create an agency relationship between the employer and the insurance carrier since the employer is acting only for the benefit of its employees and the employer's own benefit in promoting better relations between itself and its employees." Kilbourn v. Henderson, 63 Ohio App.3d 38, 577 N.E.2d 1132, 1136 (1989) (citing Hroblak v. Metro. Life Ins. Co., 79 N.E.2d 360, 364 (Ohio Ct.App.1947)). Here, the language of the statute and the bylaws confers an unambiguous contractual relationship between the City and CMIC, so the employee's participation in the Group Policy does not by itself create an agency relationship such that he becomes the policyholder. Plaintiffs' references to unreported Ohio cases and cases outside this Circuit bear no relevance in our analysis and are not controlling authority.
Plaintiffs argue that they should have received the proceeds from Anthem's demutualization in 2001. Plaintiffs identify "two paths" — Class A and Class B — to show that they are entitled to the demutualization proceeds that are governed by the Ohio demutualization statutes. As we previously stated, "Group A" consisted of the City employees who had full insurance coverage from Anthem at the time of the 1995 merger between Associated and CMIC. Under Plaintiffs' argument that the employees are the policyholders, Plaintiffs contend that the employees in Group A had "grandfathered" rights preserved and guaranteed under Ohio law that would allow them to receive the payments from the 2001 demutualization. Plaintiffs argue that Class members in Group B, who obtained full-coverage from Anthem after the 1995 merger, were entitled to demutualization compensation under Ohio law and Anthem's membership rules where the employee and not the employer is the member of the mutual company. Given our finding that employees are not policyholders, Plaintiffs argument with respect to Group A fails. Because Group A members were not policyholders, they accordingly were not covered under the grandfathered clause exception and were not entitled to the demutualization proceeds.
The analysis with respect to Group B members is more complicated. For Group B members — employees who obtained full-coverage from Anthem after the 1995 merger — Plaintiffs claim that the provisions in the 1995 merger agreements and related documents specified that Plaintiffs were entitled to equity rights at the time of the merger, thereby granting them demutualization compensation. Plaintiffs also argue that they are entitled to the stock proceeds by the addition of a fully-insured human organ transplant ("HOT") rider and Certificates of Membership, which triggered a Certificate of Membership from the City that allowed Plaintiffs to receive the demutualization proceeds.
The evidence in the record does not support Plaintiffs' theory. The record indicates that Anthem intended for the City to maintain membership rights. Anthem prepared different documentation for CMIC grandfathered groups than it prepared for group customers that contracted with Anthem for the first time after the merger. Specifically, for CMIC grandfathered groups, Anthem prepared a Guaranty Policy that confirmed that the policyholders had membership rights. Not only did this Guaranty Policy differentiate between the employer "member" and the employee "enrollee" under the employer's policy, it also explained that "[n]o Enrollee or dependent of an Enrollee shall receive any equity rights by virtue of being an Enrollee or dependent of an Enrollee."
In contrast, Anthem did not make a distinction between "members" and "enrollees" in the guaranty policies prepared for Plaintiffs' Group B members. Rather, those guaranty policies defined a "member" as "each person who has enrolled for insurance of health care benefits and who was eligible to enroll for such benefits
The district court properly concluded that Plaintiffs' interpretation of the merger document for Class B members is incorrect. The district court found that the merger document does not state that new insurance is the "triggering event." Mell, 2010 WL 796751, at *10. The merger document states in pertinent part:
(Id.) Accordingly, by virtue of the process of demutualization we are compelled to conclude that Plaintiffs are precluded from recovering any of the proceeds from Anthem's demutualization. Based on the reading of the merger documents, it is clear that Anthem did not create new membership rights for employees enrolled post-merger. Therefore, the Class B members were not eligible policyholders under the Anthem plan and were thus not entitled to receive Anthem's demutualization proceeds.
Plaintiffs also improperly apply Ohio law when the demutualization process was governed by Indiana law.
To now apply Ohio law would disrupt the entire demutualization process in which the Indiana demutualization law vested exclusive authority in the Indiana DOI to approve the conversion plan. If this Court were to adopt Plaintiffs' argument that Ohio demutualization law applied, Anthem's entire application for conversion would be discredited. It also would undo the 1995 merger agreement. Under the 1995 agreement, Anthem, an Indiana based mutual insurance company, acquired CMIC, which was an Ohio insurance company. At no point did Anthem become subject to Ohio law. As a result of the merger, all of the mutual company members of the Ohio company became mutual company members of the Indiana company with voting and equity interests in the Indiana company. After the merger, what remained in Ohio was an Ohio stock insurance company, not an Ohio mutual insurance company. Under Indiana demutualization law, however, the City, as the eligible statutory member, was entitled to the demutualization proceeds. See Ind. Code Ann. § 27-15-1-7.
Despite Plaintiffs' multiple theories suggesting that they are entitled to the Anthem demutualization proceeds, Plaintiffs cannot recover any of the demutualization compensation. The evidence in the record indicates that the City was the policyholder prior to the 1995 merger between CMIC and Associated. The documents also clearly establish that the City maintained its policyholder rights post-merger through a grandfather clause, including any rights to the demutualization proceeds. The 2001 demutualization process did not disrupt the City's membership interests nor did it confer any equity rights to Plaintiffs. Thus, Plaintiffs are not entitled to the demutualization proceeds.
For the foregoing reasons we
In this case, the amount in controversy exceeds $5,000,000 and the parties are citizens of diverse states. See (R.1: Compl. ¶¶ 1-3.)